Wednesday, November 11, 2009

I just read an article in the New York Times and thought of you all, so I thought I'd post it, even though no one is actually reading this blog anymore.....

The title: China's Tough Measures on Flu Appear to be EffectiveThe blurb: They quarantined foreigners and it worked! H1N1 is being contained!....it reminds me of Atlantic Storm and Germany's threat to Poland that we'd quarantine any Polish outsiders who came into Germany. I guess the plan would have worked.: o )

Monday, September 21, 2009

The Death of a Disease DA Henderson I really enjoyed reading this book by DA Henderson because it was the tale being told by an insider, whereas some of the other books we read for the class were more of third person accounts. I never knew one person could have such an impact on a movement as great as the smallpox eradication until I read this book, as well as Demon in the Freezer. I really enjoyed reading DA Henderson’s book, not only for that reason, but also because of his passion for eradicating smallpox. I personally do not know whether I believe that the stocks of smallpox should be destroyed, but I do know that I would agree with Henderson not wanting to keep the stocks right after the end of the eradication. I feel that his stance on this subject is really important because he was actually on the field and knew what it was like to have to struggle to give all of those vaccinations, so in a sense I feel that people should give his opinion, as well as those of people who worked along with him, a greater weight in determining whether the stocks should be kept…that is if they actually ever decide to make a decision and don’t keep pushing the dates back. One part that I do have to disagree with Henderson on though, is whether or not eradicating another disease will be possible. While he does not think so, I have to be optimistic towards the fact. While I may be less credible because I have never actually been on the site during any eradication process, I think science has developed in such a way that eradication of certain diseases is becoming more and more possible. Take for example polio and guinea-worm disease, they have both come a long way towards being eradicated and while it may take hard work and great dedication, I think successes is likely.

Biohazard Ken Alibek I LOVED THIS BOOK! I never knew so much was going on in the world until I started reading this book. Before reading Ken Alibek’s take on biological weapons, I would never have guessed that people would actually stoop so low as to create weapons out of very devastating diseases. This book was semi-frightening to me because I have personally suffered from a disease that once caused epidemics, so it took me a while to grasp the idea that people would purposefully cause others to become ill. The fact that the Soviet Union’s biological weapons program was so intensive and detailed was also a bit frightening to me. Ken Alibek put so much detail into his writing, that I nearly forgot I was reading a book at times. I found it interesting that Alibek also put so much detail about society in the Soviet Union into his book, including family structure, social structure, and a lot of politics. I like how he not only talked about the intensive weapons program but also what was going on in the world at the time. Now, looking back at the book after having experienced our amazing soco class, I found it extremely interesting that Steve Block does not trust Alibek. While he had some convincing points, about Alibek using his experiences to make a living and feeding people stories, it makes me question the authenticity of Biohazard, and just anything that Alibek may have told the US Government at all. However, overall I really enjoyed the book and thought it created a very good introduction to biological weapons and the great variety of ways that science can be used.

Demon in the Freezer Richard Preston This book was ultimately extremely captivating! Before reading this book, I was very and did not know what I had gotten myself into by signing up for this SoCo (mainly because of the amount of books that we were assigned). However as soon as I started reading the book, I was unable to put it down! The style with which Preston writes makes the book seem a lot less like it is about actual real life events, and it also makes the book seem a lot deeper than just a statement of a timeline of events. One of the more confusing parts of the book, in my opinion, was the fact that the book started out as more of a description of a case of anthrax. While reading the book, I never felt like Preston ever really went back to the original story line and completed it. Otherwise, the book created a well depicted, generalized storyline of smallpox, its history, and its eradication. I felt like reading this book was definitely a better introduction to smallpox than if I was just given straight facts. One of the most interesting parts of the book to me was the part about the eradication. Before signing up for this class, I had heard of smallpox, but I had never really considered what exactly happened to it or felt the urge to look into whether it was still prevalent in today’s world. However, after reading this book, an entire world of eradication and the possibilities of eradicating other diseases were opened up to me. Overall I really enjoyed this book, and I felt like it made me very excited for soco.

In 1999, the government (specifically the U.S. Department of Defense, the U.S. Department of Energy, and the U.S. Department of Health and Human Services) requested that the Institute of Medicine convene an independent scientific panel to investigate future scientific needs for live variola virus. That committee, the “Committee on the Assessment of Future Needs for Variola (Smallpox) Virus,” produced a report “The Assessment of Future Scientific Needs for Live Variola Virus” chronicling their conclusions. The report outlines six major scientific needs for the smallpox virus, the first and most convincing being the need for further research into the creation of novel vaccines fit for immunocompromised populations.

The assessment is particularly interesting in light of the World Health Organization’s upcoming debate as to whether or not to retain the world’s existing stocks of live variola virus. Dr. Ann Arvin (Stanford University School of Medicine), who served on the committee both in 1999 and on a recent committee to revisit the issue, commented on the differences between the two assessments, claiming that the 2009 study was far less political than charged debates of 1999. I found this to be interesting, as both reports were intended to be (and appear to be) completely independent—obviously being unbiased is tough, even in science.

The 1999 assessment is well written, providing a clear outline of the major scientific motives for the retention of variola stocks, and well as a broad overview of smallpox epidemiology, eradication, and bioterrorism threat. It is informative and accessible to the general public, and although it is very technical, I did enjoy reading it.

Throughout our course, we have repeatedly referenced the flu epidemic of 1918-1919 as a lesson for the upcoming swine flu pandemic. We never fully examined the similarities between H1N1 and the Avian Flu of 1957. After reading an article about it in The Washington Post, I am convinced that the epidemic of 1957 provides valuable lessons for the trajectory of swine flu and how to handle it.

The Avian Flu (H2N2) broke out during the normally flu-free summer in the Northern Hemisphere, and attacked many group-living situations such as summer camps and military bases. The current strain infected over 80 summer camps during the summer. Like H1N1, the 1957 virus had an overwhelming effect on younger people as compared to the elderly population that flu normally effects. Additionally, the 1957 Avian Flu was briefly harsh but rarely fatal, as H1N1 has thus far. As the article details, these similarities suggest that the pandemic of 1957 may be an instructive model for what is to come with H1N1.

Overall, the 1957 pandemic created 60,000 “excess deaths” in the U.S, which would be the equivalent of 107,000 people today. This is a substantial amount, and with such large similarities between the two epidemics, the Avian Flu of 1957 should be studied in order to prepare for the major outbreak of H1N1.

The first two books that I read for Smallpox Safari, Smallpox—The Death of a Disease and Scourge, were both fascinating and incredibly informative. Looking back, however, I realize that it is Richard Preston’s The Demon in the Freezer thatis the perfect introduction to smallpox. First, Preston’s story is informative, as he gives a detailed overview of the history and eradication of smallpox, along with the potential future threats of the disease. Second, the subject matter is timely. As Preston weaves the story through both smallpox and anthrax, he taps into the fears of the reader; both in 2002 soon after when the anthrax attacks occurred and in 2009 in a world where science and military are growing ever more connected. (Although I do agree that the presence of anthrax in the storyline did unnecessarily complicate the book). Finally, The Demon in the Freezer is simply exciting, due to the subject and the author’s gift for impressive storytelling.

Herein lies the beauty of The Demon in the Freezer, in its ability to combine a significant amount of academic information with an exhilarating literary adventure. The excitement is only compounded by the reality that Preston presents. Like most readers, Preston’s concluding words struck me: “We could eradicate smallpox from nature, but we could not uproot the virus from the human heart.” The Demon in the Freezer provides perfectly both the introductory information and the incentive to dive into the study of smallpox.

There are currently very many questions about just how effective the new H1N1 vaccine will be, seeing as how it has not yet been effectively been tested and it is a new vaccine for a fairly new illness. One of the rising areas of speculation concerns just how effective this vaccine will be and how many side effects it will have in pregnant women. Pregnant women already have so many concerns and precautions to take to assure they have a safe and healthy pregnancy in the first place, that the issue of this new H1N1 vaccine is only making matters more complicated. While it may seem that the vaccine is effective, there has yet to be published results stating what effects the vaccine has on pregnant women and their unborn children: and as a result there is currently a state of confusion about what these women should do.

According to NPR's Health Correspondent Richard Knox, " The swine flu vaccines are not specifically approved for pregnant women. But neither are ordinary seasonal flu vaccines. The reason, says FDA, is that the agency doesn't specifically approve most adult drugs for categories of adults, such as pregnant adults. If you look at the fine print on seasonal flu vaccine labels, you'll see language like this: 'It is not known whether (this vaccine) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. (This vaccine) should be given to a pregnant woman only if clearly needed.' This doesn't sound very reassuring, and it may be one reason why many obstetricians have not urged their pregnant patients to get seasonal flu vaccines."

While the CDC normally recommends that pregnant women get the seasonal flu shot, the fact of the matter is that only about 15% of pregnant women get it yearly, which is probably why this year the CDC is strongly recommending that they receive this H1N1 vaccine.

Personally, I do not know whether recommending, let alone strongly recommending, these women to receive a vaccine which has yet to be effectively tested on women during their pregnancies is a good idea. There are qualms about the effectiveness of the vaccine in itself, and not knowing whether it could cause a fatal side effect in women who are pregnant makes a logical argument to me that it should not be strongly recommended until more results are put out. But hey, that's just the opinion of a young college student who has yet to go through medical school.

According to this article on CNN.com, many women who are at high risk of getting breast cancer often take medications. Nothing seems odd about that right? Well the interesting thing is, some of these medications that women are taking to prevent cancer could have side effects such as "blood clots, cataracts, and cancer of the uterine lining." How encouraging is it that a medication you would use to prevent something as horrible as cancer could lead you to have a different type of cancer?! While we've learned that all drugs have their side effects, this article encourages weighing the pros and cons of taking drugs such as "tamoxifen or the osteoporosis drug raloxifene."

According to the chair of the American Cancer Society's breast cancer advisory committee, Dr. Christy Russell, the more prevalent issue may be that not enough of the 2% of women who are at high risk for breast cancer are taking drugs to prevent it. Dr. Russell states that there is a certain level of difficulty in convincing the current culture of the importance of taking drugs to treat an illness that they do not yet have. While it may seem logical, would you actually take medicine with such varied side effects to treat something you were not yet diagnosed with?? I am not sure that I would...

We talked alot during our soco about masks, and even had Mark Liao come in to demonstrate and explain the effectiveness of masks. According to this article in the LA times, health care officials working with patients with swine flu should wear N95 masks and not surgical masks. The Institute of Medicine says that surgical masks are much more loose fitting and provide less protection against small vapor particles that could potentially carry swine flu than N95 masks. There are some arguments going around about whether masks are actually worth the costs, but so far health care officials are being encouraged to use N95 masks in these situations

Interestingly enough, on this website, according to Vancouver's Chief Medical Health Officer, surgical masks may not work to prevent the spread of swine flu. This consensus is a result of the idea that the particles containing the virus will be spread more easily as people touch the mask to remove it and then proceed to touch their face, etc. Vancouver's Chief Medical Health Officer is also advising parents against sending their children to school wearing masks, claiming that this will increase their chances of getting sick rather than decreasing them.

Sunday, September 20, 2009

Apparently more health officials are seeing a rise in girls and young women who have the HPV virus. This HPV virus (as we've talked about in class) is linked to cervical cancer as well as other illnesses. Just to play devil's advocate...could this rise in the number of women with HPV be linked to the rise in women receiving the HPV vaccine? While I know that it is unlikely, watching the video in the news report on this website makes me question why there are more cases of HPV being discovered in women 18-20 years of age. Scary thought : cervical cancer is the 5th most deadly cancer among women. Health officials say that spreading the message about the importance of getting this vaccine is one of the greatest ways to prevent cervical cancer that could have been prevented.

This book is a useful compilation of Jenner’s work concerning inoculation against smallpox. With Jenner’s three articles is one place you easily see how he developed his ideas and tested his observations surrounding smallpox.It is important to note that the scientific approach to thinking that is evident in these pages was somewhat of an anomaly in this 18th century era. Jenner provides a lot of evidence to support his theories connecting cowpox and smallpox. He describes in sufficient detail for the numerous case studies which he performed.Although it is a scientific set of papers, it reads like a simple, logical story unlike today’s scientific literature laden with specific jargon. In addition to the scientific aspect, Jenner also finds ways to make reference to those who are skeptical of his work.It is interesting to have a glimpse into the mind of a man who developed a novel way to prevent the “severest scourge of the human race”. Jenner seems to have had an inkling about the magnitude of his work as he was “ encouraged by the hope of its becoming essentially beneficial to mankind.” For anyone studyingmedicalor scientific history, these original texts are a must read as the development of vaccines is key to preventative medicine today.

Disclaimer : So apparently I saved a bunch of my blog posts as drafts and never published them because I guess I got distracted by something else?...and they really aren't relevant now [or were covered by some of you all...so excuse the mass posts by me that are to come in the next few hours :(]

Anyways, so it's not just Vaden that is preparing for the impending doom that Swine Flu will bring about on college campuses. One of the major reasons why germs are so easily spread around campuses across the country is because college students are always in situations of close contact or close proximity. The parties, drinking, and beer pong doesn't necessarily help prevent the spread of germs and bacteria. Currently, San Jose State University is planning on handing out disposable thermometers to fraternities and sororities, and has also made provisions that in the case that swine flu does break out, there will be a house designated specifically for people who are sick.

According to Mercury News, "More than 80 percent of the nation's colleges and universities tracking swine flu cases have reported infected students, up from 73 percent of all schools the previous week, according to the American College Health Association. Most cases are mild, running their course in one week. But it has claimed the lives of two college students so far, one at Cornell University in New York and another at Troy University in Alabama." These are scary statistics! Will our campus be next? What will Stanford do if so many people on campus get swine flu that some form of housing needs to be designated for them?

Berkeley (no matter how great the rivalry between us is) has unfortunately felt the pangs of swine flu infections and reported between 40-50 cases that appeared to be like influenza weekly. Unfortunately for us, swine flu aims more at young adults and children rather than older generations...And all of this constant close contact (in-between classes, shared bathrooms, dining halls, dorm rooms, etc.) is probably swine flu's best friend when it comes to making more people sick.

Hopefully swine flu doesn't hit Stanford as hard as it has hit some other schools. It would be great if there never turned out to be a single case of swine flu, but seeing the statistics and how many other universities have come down with cases, it is highly unlikely that the "angel of swine flu" will pass over our home sweet Stanford.

Saturday, September 19, 2009

Hey Pox Stars! If there’s any practicable lesson we could have taken from Bob’s class (aside from the skillful timing and technique it takes to jump in the air with 15 other people), it was that vaccines are a lifesaver. If you haven’t received a seasonal flu vaccine yet, there is no excuse because Stanford will be giving away FREE vaccines to employees and students. I saw this on the Vaden website, and I had to tell all of you!

After Roz Diane Lasker’s simulation and Bob’s re-simulation on the “what-ifs” of a biological attack, I thought that these scenarios could be brought down to earth a bit more. As I see it with the H1N1 pandemic, these scenarios are already happening. There are some definite parallels between some of the suggestions our class gave to solving the hypothetical biological outbreak and the H1N1 pandemic happening in real time.

At Stanford Medical School, trials have been underway to test the H1N1 influenza vaccine. The National Institutes of Health (NIH) is sponsoring the phase-2 trial at six sites around the country. At Stanford, there is a call for 130 volunteers, with 2/3 of this number in the 18-64 age category (I believe our very own Josh Wong is among this group!) and the rest from 65+ above.

The government response stemming from the NIH to disperse resources and mobilize university, intellectual, and volunteer efforts is a common theme among any outbreaks, viral or biological.

As we go back to school soon, the spread of the H1N1 flu strain is expected to diffuse itself among the school-age population more as we have seen happening at several universities. And as much as our class talked about mass vaccination vs. ring containment, decisions like these are happening at this very moment! The federal government is waiting to hear from trials already under way before making a final decision about whether to proceed with a large-scale national immunization program.

But there’s a problem . . .

Stanford Medical School reports: “The government, which had hoped to have 120 million doses of the H1N1 vaccine on hand by Oct. 15, announced on Aug. 18 that, because of delays in the manufacturing process, it now expects only 45 million doses to be available by then.”

Does this predicament remind anybody of the same problem us delegates faced during Atlantic storm? A huge debate we had was whether the smallpox vaccine should be diluted or not. This controversy may be placated with some of the experiments taking place at Stanford Medical School. Trial is underway for the introduction of a novel vaccine that contain an adjuvant: “a substance that stimulates the immune system so that it attacks the virus more vigorously.” With the use of the adjuvant, it may be possible that the dose of vaccine could be lowered, allowing for more people to be immunized.

Hopefully, this will be a great breakthrough to help placate any tense relations forming between Germany and Poland. Way-to-go for friendly mediating efforts from the nearby Sweden!

How can scientists engineer a disabled vaccine to make it as potent as a “live” vaccine but as safe as a “killed” vaccine?

Disabled viruses have been effective in the production of vaccines for smallpox and polio. However, for non-viral diseases like tuberculosis and malaria, the immune system is able to recognize that the viruses in these vaccines are disabled, and hence, the immune system will not trigger the anticipated antibody response.

The co-author of a study that suggests a solution to this problem, Daniel Portnoy, a UC Berkeley professor of molecular and cell biology and of public health, explains, “What this says is that the immune system knows the difference between a live bug that's virulent and a dead one that is harmless." Furthermore, Portnoy says that not only is there no immune response, immunity is also suppressed.

To solve this problem, the study suggests getting the microbes to act as if they’re alive. The strategy is to select new bacterial strains that induce the right kind of immune response.

The pathogen seems to take on a personality and these mannerisms within the cell affect how the immune system will respond — “where it goes in the cell, what pathways it interferes with, and how disruptive it is.” A vaccine against these pathogens would need to have an effect of inducing T cell response, a condition that does not happen with currently available vaccines.

Flash back three months ago towards the beginning of the summer, I was sitting in my bedroom, staring at the nine books that laid on my floor. I was deliberating too much intensely about which book I should crack first and how I would assemble a reading chronology that would introduce to me the various facets of smallpox in the best order possible. One by one, I began shuffling through the pages, reading the introduction and first chapter of each book. By the time I got to D.A. Henderson’s “Smallpox—The Death of a Disease,” I knew that this was the book to start me off on my summer of smallpox.

The book combines the elements of all our other reading in a rounded way. It begins with the historic scourge of smallpox (Pox Americana, Rotting Face, Plagues and People), discusses 20th century bureaucratic battles, details the eradication, and terrifies readers about past and impending biological disasters (Scourge, Biohazard, The Demon in the Freezer).

I was so impressed by DA Henderson. This was the person who had made it happen and he was able to share his story, thanks to a grant from the Alfred P. Sloan Foundation that encourages scientists and public servants to write to the world . Reading Henderson’s book made me reconsider to what purpose was I working for a college degree. At that time in my life, I had thought I wanted to settle on a path towards an MD/MPH. It turns out that Henderson didn’t even care much for degrees and professional background in assembling a team. He writes, “[The] staff members made up for a lack of formal public health training with intelligence, common sense, flexibility, and imagination.” There was John Wickett, the mathematics major and ski bum who started in computer programming with the smallpox team, and then taught himself about WHO bureaucracy and smallpox, sticking around for 18 more years. After following Henderson’s tales about his team members, I realized that academic pedigree had no bearing for employment in the fields of these 3rd world countries. What mattered were characteristics like flexibility, persistence, innate competence, and a pinch of creativity.

This book is a great example that illustrates some of the lessons we have learnt during our SoCo about risk taking and being open to the serendipitous moments that passes by in life (Thanks, Bob!) . The smallpox eradication job fell to a person who felt he was overwhelmingly under-qualified for such a role, yet who took that risk anyways and would uproot his family to Geneva for ten years. While Henderson’s telling of the eradication plan did get redundant after descriptions about country-hopping from within Asia to Africa to South America, I think the greatest element to pull from the book is learning from the life of Henderson himself and the decisions and sacrifices he had to make to follow his gut feeling that anything is possible, including smallpox eradication.

Friday, September 18, 2009

Smallpox, Smallpox, and more smallpox. When someone asks me what my SOCO is about, that is what I say. But then I launch into a 15 minute description of all the cool things we do surrounding this subject. Even 15 minutes does not do justice to probably the best 3week class I've ever taken. And of course, its not all about what the class was about. It includes the teacher, the SCAs and the fellow students. It is impossible to describe this all in one word. Bob: engaging, eccentric, awesome, brainiac, creative, unique; i mean, what other teacher of yours has written a poem about a virus? Takes a jumping picture wherever he goes, domestic or abroad? Puts on skits with his SCAs dressed up as cows and death reaper? Stars in student's musical videos? Takes pictures of a BBC crew? Asks extremely thought provoking questions? Gives some of the best advice I've received? And relates to everyone's interests? Manages to keep our interests alive even after two weeks of 10-4/6 hr school days? That is rare to come by. What other SCA is willing to talk continually and repetitively talk about his/her experiences? Dress up as a cow and death reaper? Stalk important people so that they can come talk to us? Offer to help us in our journey as students? Is excited that he/she will still be seeing us even after SOCO is over? Gives up an entire three weeks of summer and even more in planning in order to make sure that we get the best out of the class? Try their best to be in class with us despite their busy schedules? Has the best sense of humor? Get sooo excited about a simulation in which they're not even participating? I could go on and on but my point here is that Bob, Aaron, Josh and Lauren have been the best teachers i've ever had; and the best thing is that I feel I have made four new awesome friends. I am sure everyone agrees with me in saying that this class has been the best combination of learning and having fun that most of us have had.Now to talk about the class: as it was the best combination of alot of learning and alot of fun, I am now interested in something I never considered before; this class just turned on a spark in me that I never new was there. Now I have a sincere interest in epidemiology and virology; I have absorbed so much information and the best thing is that this class, through Bob and the SCAs brought everything together. Everything that I remembered from high school biology and a class on biotech. Whether it was plasmids or vectors, everything just clicked. I really enjoyed this class. I cherish the experiences: Jasper Ridge, ATLANTIC STORM, GSID and Don Francis, jumping pictures, the movies,OUR movie, the Baylands(or should I say the Palo Alto landfill haha), RAMEN... It was over all a great experience in all ways possible. I came expected to be bombarded with more smallpox facts and I left bombarded(in a great way) but not with only smallpox information but with lots of great advice, good memories. I feel more aknowledged three weeks later. They really care about our success in school and in life. What a good feeling!I don't mean to sound toady and if thats how it comes across, then what I am really thinking can't be expressed in good words, at least not by me and my ENL(english as an nth language) skills. It has been great to meet my fellow classmates of course because you guys are what helped make the class more exciting. I can't think of anyone else I would have wanted to have in this class you but you guys. It was so fun, I really actually enjoyed myself. It was a class, but it didn't really feel like a class (most of the time anyway), especially when we all loosened up after a couple of days. It was great. I am sure I will see all of you at some point in the future. Keep it real and have a great time this year, I for one am excited for this year (not for classes, but they are a part of the process). Stay well and try not to get that viral infection!!Sincerely,Aimee

There have been reports of polio, measles and cholera outbreaks in northen Kenya as a result of water shortage caused by drought and an increase in the number of Somali refugees in the east. There has been a slight increase in polio and measles cases. Since February, 18 polio cases have been reported in Turkana and it is believed that the virus was imported from Sudan due to rampant cross-border motility. 18 cases are significant because before the first reported case, Kenya had lasted reported a polio case over 20 years ago. And in a neighboring refugee camp, three measles cases have been reported. In another refugee camp, 62 cases of measles have been reported and as a result, a nationwide vaccination campaign is going to begin September 19. There has also been an outbreak of cholera. So far 600 cholera cases have been reported in Turkana. Cholera, like botulism, is an infectious gastroenteritis caused by the bacteria Vibrio cholera, which produce a cholera toxin. It is transmitted through eating or drinking food or water contaminated with the bacteria from other cholera patients. SO far, thirteen people have died but that is only counting those deaths that have been reported. The concern is that the residents of a northern Kenyan town called Turkana are drinking contaminated water from a nearby lake. Among other reasons, the water is partly contaminated because the town has low latrine cover, leading to the improper disposal of waste. As unimportant as this might seem to some of you, it shows the obstacles that the current measles and polio eradication campaigns are experiencing. Whether it is due to natural disasters such as drought or floods or human induced disasters such as wars, it is causing unexpected setbacks. I don’t think Lemaat listed Kenya as one of the three countries remaining with polio, in which case there are now four countries and the number might continue to rise as a result of the movement of refugees and the occurrence of natural disasters.

Henderson takes one of the monumental achievements in disease history and makes it readily accessible to the general public in a very fascinating portrayal of the eradication of smallpox.

What strikes me most about Henderson's perspective is how candid he is about his experience as head of the eradication. He is characteristically open about his efforts, often revealing the actual disease to be less of a problem than dealing with his superiors. If he makes anything obnoxiously clear, it's that when working on a global project one must choose the people to work with and ignore the calls of everyone else to get something done. The ins and outs of the WHO bureaucracy are very clearly present throughout the entire book, necessitating a search for loopholes that could only be carried out by our very cheeky, irreverent author. It's difficult not to admire his no-nonsense approach.

The book itself quickly documents how Henderson serendipitously was given the position that would define his career and then jumps into eradication. He goes through in minute, yet engaging detail the evolving strategy needed to tackle such a beast with little more than a picture of a dude with smallpox, freeze-dried vaccine, and a bifurcated needle. The only thing that I would chance criticizing in his book would be the slight repetitiveness of some of the chapters. While I'm sure the actual process was much more complicated, the ring-vaccination technique coupled with stringent surveillance seemed to be the general gist of more than half of the discussed regions, with slight adaptations for weather and political conditions in the remaining situations.

Even so, for one who is interested in the topic, I can't think of a better source than Henderson. The last few pages are a very nice capstone to the book, collecting what he gathered from his experiences to formulate his own strong opinion on where we should go from here. Definitely worth the read if you like poxy stuff.

DA Henderson’s personal account of the Smallpox Eradiation Program is filled with well researched, comprehensive detail that gives the full scope of the eradication program in its full capacity. He dutifully describes all the facets of the program, including the political, social, cultural, religious and economical issues that surrounded the eradication program as well as the disease itself. And he gives his account with a lot of passion and commitment to the message he is relying. One of the things I found most intriguing about DA Henderson’s book is his detailed description of the struggles and difficulties he faced while dealing with the World Health Organization. This detailed mostly with the political facet of the eradication, as this program was global and required the participation of nearly every single country because if one was affected, everybody else was at risk. And so, it is with disbelief that we read about the miles of bureaucracy that he had to go around in order to succeed even though he was doing everyone a big favor, whether or not they were involved. Such an account serves to show that sometimes, one must break the rules or disagree with the big players even though it might mean making one’s life ten times more difficult. It is in facing obstacles such as these that the true leaders are exposed. It also serves to illustrate that not everyone in charge has the best interest of others at heart. I was particularly disappointed by director Candau of the WHO and others like him, who did nothing to help or did everything to discourage the continuation of the program. If its people like these who are in charge of an organization, such as the WHO, that is supposed to advocate and fight for those who have no voices, then we need many more DA Hendersons, Don Francis’s, and others if we are to make any more magnificent advances in humanity’s fight against diseases.

Richard Preston has great story telling skills. He is so talented that when you're reading one of his books, you can actually picture what is going on, whether or not what happen was in your lifetime is regardless. Now, someone will say, that the idea of storytelling is making a person feel like they're living the story. Well, Richard Preston definitely does not fall short of this. In fact, he goes above and beyond given the generous amount of information at his hands. He manages to organize and connect every detail trying to leave nothing out. I saw this in his other great science nonfiction book, The Hot Zone, where he details the outbreaks of several hemorrhagic fevers in several places around the over a forty year timeline. In The Demon in the Freezer, he has tons of more information: over a hundred years’ worth, maybe even more. Yet he tells its like a story and not like a long boring historical documentary. One of my favorite things about this and his other books, is how it combines history, virology, humanity, compassion and conflict in only 283 pages. Granted, there is more to the story but he briefly but coherently touches upon it all: from the launch and progress of the eradication program to Soviet defectors, the retention vs. destruction fight, the description of what occurred during the 2001 anthrax terror scares, research at major US labs like Fort Detrick and more. And amidst all this talk about viruses and bioterrorism, he manages to insert personal anecdotes about several people, appealing to the human side while grasping our attention. One of my favorite quotes comes at the end when he says:"We will never find an explanation…for the love that drove the doctors to bring smallpox to an end. Yet after all they had done, we still held smallpox in our hands, with a grip of death that would never let it go. All I knew was that the dream of total Eradication had failed. The virus’s last strategy of survival was to bewitch its host and become a source of power. We could eradicate smallpox from nature, but we could not uproot the virus from the human heart."In a personal display of great thought provoking insight, Preston leaves us thinking about what should or should not be done, what is better for humanity and whether we will ever be able to part with this virus.

Ebola and Marburg, Plague, HIV, Smallpox, Tuleremia, Anthrax etc. We are all familiar with these horror inducing viruses and bacteria as causes of some of the worst diseases that humankind has ever seen. We don't completely realize how horrible they are unless we ourselves have experienced them, we therefore,do everything we possibly can to avoid them. Imagine somebody's surprise and horror, when one learns that one of the largest most capable nations, has been at work for decades working on ways to bring the diseases to us. That is basically a summary of my thoughts when I was reading this book. Ken Alibek, former director of the Soviet Union's top biowarfare production facility, Biopreparat, describes in full detail and without holding anything back, the full scope of the Soviet Union's commitment to use nature to its(USSR's) advantage against fellow humans.For me, this book arises a lot questions and thoughts about several things. One major issue being our innate tendency of submission. Before and during the Cold War, Russian leaders encouraged scientists, who as doctors had promised never to intently harm human life, to produce some of the deadliest weapons of mass human destruction we have ever seen. They enlisted propanganda, a prime weapon, to brainwash people and instilled fear in them; fear of being caught thinking bad thoughts; fear of being reprimanded for associating with a known dissenter; fear of being punished for a mistake; fear of anything deemed suspicious. With these two historically successful weapons (fear and propaganda) the USSR enlisted some of the most brilliant minds science has ever seen in this race to destroy humanity. Sounds hypocritical? That's what politics is. It is therefore important to realize that for someone as important as Ken Alibek to defect, there must have been something going on there that was so bad that it was breaching the sometimes lacking ethical and moral beliefs of the scientists (for the few who were aware of the full implications of their research). Most of the current United States biodefense strategy and biowarfare intelligence is based on what Ken Alibek had to say when he defected from the Soviet Union. What he had to say was both chilling and very helpful because it helped launch an emphasis on bioterror in the United States and around the world. Once I opened the book, I could not put it down, suspenseful as it was in a very realistic way. In a way, it was so suspenseful because what he describes is something one can only imagine in a science fiction movie. The little fact that twists everything is that this book is NONfiction. Everything is real yet as you read, you find it so hard to imagine that something like that could be carried out by your fellow humans. My conclusions: what else are people going to start using as a weapon of mass destruction? What's next before hell breaks loose?

Smallpox: The Death of disease is an intriguing, true story about the smallpox global eradication campaign told by the man who ran it himself, Dr. D.A. Henderson. After providing a solid foundation with a summary of smallpox history, he plunges into the course of eradication. Henderson gives a unique anecdotal insight into a few of the intricacies and personalities that shaped the campaign program. The story travels through each country and phase of the eradication where floods, mechanical problems and not to mention cultural resistance were around every corner. Misguided politics had a significant influence as well.Fortunately, Henderson’s hands on approach and disregard for inhibitive regulations lead the effort to success.

The reader also gets a glimpse behind the scenes of the eradication certification program as well as the chilling biosecurity issues that have surfaced post-eradication. Henderson has continued to play an important role in advising the government on how to prepare for potential bioterror attacks involving smallpox. However, he concludes with a surprising opinion about future eradication efforts.

Overall, the story is engaging from cover to cover.Henderson’s anecdotal account of the campaign provides a unique dimension, which no other smallpox literature can provide. The lessons learned from this achievement should serve as a template for future global effort as well as personal life goals. In addition, smallpox aside, this inspiring account is evidence that no obstacle can inhibit a strong a will.

Like Hai-y, I was deeply impressed by Pox Americana. Most of the other texts we read focused on the biological and sociological impacts of smallpox on a very specific population, either as a distinct bioterror threat or as a wide-ranging epidemic. Pox Americana was impressive in its specificity. In choosing to focus solely on the American Revolution, Pox Americana was able to specifically detail the effects of the disease on a population already affected by the war.

Personally, I had never before thought of the American Revolutionary war in terms of a disease epidemic, and this book made me consider the outcome in a more systematic way, The deterioration of the revolutionary army as a result of the epidemic must have surely altered the course of the war, yet the Americans still emerged victorious.

I was deeply impressed by Fenn's research into the way the prevalence of smallpox played into the overall effects of the revolutionary war. George Washington, in particular, emerged from Fenn's novel as a forward-thinking figure determined to avoid a horrible fate, yet committed to the surely fatal battle ahead.

Fenn's use of vivid specific detail was extremely valuable from a historical epidemiological perspective-- the Indians who contracted the disease as a result of a potential genetic predisposition to it have not been forgotten in Fenn's work. The terrible epidemic spreading through the North American indian population is given thoughtful treatment. I personally appreciate the disease-oriented specificity of her research, yet the broad-ranging implications it has into epidemiology as a general field.

Thursday, September 17, 2009

Richard Preston opens the Demon In The Freezer, in dramatic fashion. He recalls the death of Robert Stevens, one of the victims of the anthrax mail attacks launched after September 11th. This is followed by a gruesome autopsy and the frightening identification of the pathogen. This thrilling start draws the reader into the chilling reality of deadly biological warfare.

The intensity of the first chapter is maintained as Richard Preston describes an outbreak of smallpox in Germany. The most terrifying part of this is the attention Richard pays to the symptoms of the infected patient. His emphasis on the symptoms smallpox leaves a lasting impression about the truly horrific nature of infectious disease.

Richard Preston’s storytelling ability gives the book an edgier feel. It has all the appeal of a primal thriller, where scientists and doctors attempt to track down and kill a mass murderer. Here there are two culprits Anthrax, a stealthy, precise killer and Smallpox, a terrifying, indiscriminate slaughterer.

Richard Preston intertwines the race to eradicate Smallpox from the globe, to the artificial use of Anthrax as a Bioweapon. He these two events to inject urgency into the book, as one cannot help but contemplate the dangers of smallpox in terrorist hands.

This technique means however, that even though chapters and events in the book are thrilling and fascinating, the narrative doesn’t quite flow that naturally. This can make the book feel slightly disjointed at times

Overall however, Richard Preston’s superb rapid-fire story telling coupled with his amazing attention to detail, make for a thrilling, yet frightening read about the potential of a bioterrorist attack.

In the purported speech given by the Mandan War Chief before he died, the Chief indicted the White Man for their crime: “I have Never Called a White Man a Dog, but to day, I do Pronounce them to be a set of Black harted Dogs.” Most of us have learned this by now – that the White Man screwed up a lot of things for a lot of people. Disappointedly enough, in his book, R.G. Robertson chooses the blame game again and misses out on the opportunity to present new insights on the cultural, social, and economic phenomena experienced during smallpox’s scourge in America. “Rotting Face” becomes a mere telling of facts detailing to readers what they already knew: That, boy, oh, boy, the White Man sure did screw things up again for the Indians.

Readers are inundated with facts that become daunting paragraphs one after another. R.G. Robertson places blame of the Indian smallpox outbreaks on individuals, forgetting to factor in crucial points that history has taught, such as prevailing social attitudes or the weight of faulty public health opinion. The stand-out character in “Rotting Face” is Francis Chardon, a trading post commander introduced in Chapter one and who lasts until the final pages. Chardon’s story is fascinating, but the exhaustive research Robertson churns out on this single character turns out to be the author’s crutch. Ultimately, Rotting Face delivers a story about Chardon, relying too heavily on the journal entries written by Chardon and spinning these observations into narratives about the commander’s interaction with the Indians.

I appreciated the sentimental pieces added to “Rotting Face,” such as Charles Larpenteur’s valiant efforts to help the stricken Indians, among whom were his loved ones. Yet, these stories were over-extrapolated, becoming segments about individuals here and there and forcing smallpox to relate in some way. R.G. Robertson does a fine job in his book, but his analysis on this subject is one that has been done enough times already and now needs a novel approach towards looking at American Indian history.

Frankly, Biohazard terrified me. It was not the detailed descriptions of biological weapons facilities nor of the massive, faceless Soviet political machine that drove the development of this immense program that chilled me. It was Ken Alibek himself. Admittedly, he wrote the book in conjunction with another author, but the voice he established for himself as a narrator was flat and emotionless. As Alibek describes his development of exciting new technologies to weaponize tularemia, his tone is that of a detached scientist. Throughout the work, one of the consistent themes is his focus on the importance of his career and advancement above all else. Several times, he mentions the potential to have moral qualms about the work he was doing—but that he himself did not feel it—at the time. Each time he says something like this, my expectation of his soon-to-come complete change of heart increased. In the final chapters, anticipating his defection to the United States, I expected him to have some sort of moral crisis and understand the potential consequences of his scientific breakthroughs. Yet when the time came, Alibek’s defection seemed to be more of a function of his desire for control over his career than any other more humanitarian motivation. As his boss, Kalinin’s overbearance increased and the Soviet government’s control became more tenuous, Alibek’s frustration over the instability of his situation became palpable. His desire to leave the country came to a head when he found himself about to be forced into a job he did not want.

Now, he works as a consultant in the United States. He gains valuable defense contracts through his biological weaponry know-how. Throughout his book, he expressed no real remorse for his role in the creation of the weapons; simply for the existence of the weapons themselves, as though they emerged out of thin air. Alibek’s motivation in writing this book, then, if one assumes that it is not an apologia for his time in the USSR’s biological weapons program, seems solely self-promoting. Bolstering his image as a bioweapons expert is likely to raise his profile and augment the preexisting culture of fear surrounding biological weapons. Both of these things are likely to benefit Alibek’s career in the United States, something with which he seems to have remained consistent in pursuit of.

Bob was right-- the end of the Spanish Hapsburg line was not caused by inbreeding alone. However, the legendary "Habsburg Jaw" certainly was. A testament to the effect of a large proportion of homozygous alleles, the heavy jaw was present from the time of Maximilian I's grandmother on. In its most severe form, it could inhibit talking or eating, and it was the stuff of many monikers (Leopold "the Hogmouth").

As you may recall from my presentation, Maximilian's grandson Charles V split the line into two branches, and the deformity continued through both royal families. There have been few studies on hereditary prognathism, but most experts agree that the level of intermarriage among close relatives was likely to exacerbate the degree of the deformity, but not necessarily its prevalence among family members.

The degree of intermarriage among the Hapsburgs can be illustrated by Philip II, who married an two cousins, and a niece (at different times). His final marriage to his niece was the first of three such marriages that brought forth Charles II, the final Hapsburg king of Spain. Philip II's great-grandmother was Juana 'the Mad' of Castille, who brought mental instability to an already impressive litany of familial problems including asthma, epilepsy, and, apparently, as Bob indicated, a weak resistance to syphilis, which may have been spread prenatally. The gene (or gene combination, it is unclear) was estimated to effect 50% of the Hapsburgs, and thus was likely a recessive trait. Now that the Hapsburg blood has been sufficiently diluted by a broader spectrum of marriages, it is no longer in evidence on a consistent scale today.

When I started reading “The Demon in the Freezer,” I was convinced I was reading a thriller novel.The bioterror threat itself seems like science fiction.That Preston’s work uses the thriller framework to present this terrifying, alien threat only makes his writing more effective.Preston’s book is above everything accessible.The writing flows, a story emerges, and you become engrossed in the characters involved, notably Peter Jahrling and Lisa Hensley.These aspects make the bioterror threat more urgent and human, while still utilizing its unable-to-look-away-from-a-train-wreck nature to draw and hold readers.

While not heavy on the science, I still learned from this work.I shared D.A. Henderson’s credulity when monkeys were successfully infected with smallpox, an event that I had not read about in other works.I also learned about the IL-4 experiment in mice and was shocked at the availability of public information that could be used to make a biological weapon.Further, I think it was a good idea to tie the anthrax events to smallpox.The more recent anthrax attacks give the smallpox threat added weight and highlight the difficulties in detecting and tracing bioterror perpetrators.

This work succeeds because it presents very serious, scientific issues in an approachable way, so that all readers, regardless of their scientific background, can participate in questioning the ethics of science and biological weapons in our society.These are issues that go beyond simply scientists: they affect everyone.This is definitely a must read that ends too soon.I commend Preston for making science manageable for all and for revealing humanizing insights into the biological weapons threat.

The following is from the White House's Homeland Security Website. I find it entertaining how broad it is, and how little information it actually provides. We certainly have more information than the general public. Thank you, government, for keeping us all SO informed.

"Strengthen Our Bio and Nuclear Security

Attacks using improvised nuclear devices or biological weapons, as well as outbreaks of a pandemic disease, pose a serious and increasing national security risk, We will focus on reducing the risk of these high-consequence, nontraditional threats:

Ensuring that decision-makers have the tools they need to manage disease outbreaks by linking health care providers, hospitals, and public health agencies. By building on America's unparalleled talent and through international partnerships, we can create new drugs, vaccines, and diagnostic tests, and manufacture them more quickly and efficiently.

Strengthening our nuclear security by enhancing our nuclear detection architecture and ensuring that our own nuclear materials are secure. By establishing well-planned, well-rehearsed, plans for coordinated response, we will also ensure a capability that can dramatically diminish the consequences of chemical, biological, radiological or nuclear incidents."

Science comes as a sub-category on the White House's website. Here's what the Obama Administration says. (I'm still checking to see if they say anything about biological weapons)....

"In the past, government funding for scientific research has yielded innovations that have improved the landscape of American life — technologies like the Internet, digital photography, bar codes, Global Positioning System technology, laser surgery, and chemotherapy. At one time, educational competition with the Soviets fostered the creativity that put a man on the moon. Today, we face a new set of challenges, including energy security, HIV/AIDS, and climate change. Yet, the United States is losing its scientific dominance. Among industrialized nations, our country's scores on international science and math tests rank in the bottom third and bottom fifth, respectively. Over the last three decades, federal funding for the physical, mathematical, and engineering sciences has declined at a time when other countries are substantially increasing their own research budgets. President Obama and Vice President Biden believe federally funded scientific research should play an important role in advancing science and technology in the classroom and in the lab."

R. G. Robertson’s Rotting Face: Smallpox and the American Indian relates the 1837-1838 smallpox epidemic that devastated the Native American population. The topic certainly fills a void in the smallpox and Native American literature. Robertson reveals the interdependent relationship between the Native Indians and the settlers’ fur trade. Other secondary elements surface as well such as the power of an Indian woman and the amount of interracial mixing that took place outside of the towns.

Robertson tracks every step of the epidemic as smallpox attacked “ like a scythe mowing the summer hay.” I appreciate the attention to detail in everything from the fur trade hierarchy, to smallpox symptoms to an Indian chief’s attire.However, at times the author’s pain-staking details prove to be a fault and make for tedious periods in the book.

In addition, the work is written for the general public as essential terms applicable to smallpox and Indian history are clearly defined. Robertson does plainly admit some potential inaccuracies in his statistics and references due to an incomplete record of Native American history. Although he makes this disclaimer, he makes many assumptions and relates them in the format of “ No doubt Chardon felt…” and “No doubt Chardon thought…”, a bit of an excessive liberty in my opinion.

Despite the criticisms, I would recommend this book because it adds an untold piece to the puzzle of smallpox history and American history.

At a meeting of flu experts sponsored by the Institute of Medicine, expert Michael Worobey, who specializes in tracking viruses on the “molecular clock” said that the new pandemic H1N1 flu has been hiding in pigs for a decade before it jumped into the human species. Molecular tests show that this virus made a “mutational Jump” intohumans only recently as humans continued to interact with pigs. He also believed that it continued to circulate undetected in humans once it made the jump for a few more months; thus, he says, there is an obligation to improve surveillance of swine flu in pigs and humans. The goal of this meeting, called by the Institute of Medicine, was to examine the pandemic and look for better ways to be prepared and deal with the next one, not that one is coming for sure but viruses ARE everywhere just waiting for when the time is right.

Worobey said that if doctors tested patients for influenza, we could have caught this virus a month or two before we did.It is therefore hard to determine when and where it first jumped into the human species because by the time we found it, it had been circulating in Mexico and the US for months.

The new strain has bird-like genetic sequences and is believed to have jumped from birds to pigs a long time ago.Apparently, once it jumped into humans, its genes changed quickly, evolving at a 1.5x faster rate than it evolved in swine. And to the relief of doctors and healthcare workers preparing for the global vaccination campaign, the currently circulating virus is not mutating but experts believe it will eventually begin to. What’s next??

Wednesday, September 16, 2009

With his taste for unceasing globe-trotting adventures, Dustin Hoffman’s character from "Outbreak" may belong to the group of genetically superior people in our society who can function perfectly well with minimal amounts of sleep. I don’t know whether to look at these super-humans with jealousy or pity, but a 68-year-old woman noticed how peculiar her sleeping habits were and volunteered for sleep research. Her nightly routine consisted of going to sleep at 10 PM and waking up at 4 AM. Researchers at UC San Francisco examined the woman’s DNA and her sleep variable gene, called DEC2.

This gene was inserted in mice and the researchers discovered that the mice functioned normally despite fewer sleep in comparison to the control group that did not receive the DEC2 variation.

Stanford researchers also got involved with the project, posing two questions. They asked whether sleep among the insomniac mice were deeper than those without the DEC2 gene. Upon this inquiry, they discovered that the insomniac’s mice sleep were no different than the control group. The Stanford researchers also asked whether interrupted sleep patterns among the two groups affected waking performance, and they found out that the mice with the DEC2 variation were more robust in their physical activities.

More exciting questions are yet to be answered. The researchers want to explore whether people with sleep variations have different moods and temperaments. “Do they have more positive outlooks or are they less depressed? Are they more driven, and could that explain why they sleep less?”

Perhaps we can help by sending our professor and SCAs over to the lab for research.